Efficacy of nasal irrigation with 2.2% hypertonic seawater in the treatment of chronic rhinosinusitis in adults

Authors : Strnad P, Skoupá J, HornÍk P, Cimrová H, Cerná V. (Prague)

Ref. : Rev Laryngol Otol Rhinol. 2016;137,1:3-10.

Article published in english
Downloadable PDF document english

Summary :
Objective: To evaluate the efficacy and the tolerance of nasal irrigation with 2.2% hypertonic seawater in the treatment of chronic rhinosinusitis (CRS) in adults either used as mono­therapy, or in combination with intranasal corticosteroids. Method: In this prospective, open-label, multicenter controlled trial, 238 patients diagnosed with CRS were randomly assigned to three groups: group 1 with intranasal corticosteroids (steroid), group 2 with nasal irrigation with hypertonic seawater (seawater) and group 3 with a treatment combining intranasal corticosteroids at lower dose and seawater (steroid+seawater). Nasal index score (NIS), patient health status, intranasal corticosteroids intake, tolerance were assessed at baseline, week 2 and 6, and satisfaction at week 6. Results: NIS was significantly improved in group 2 (seawater) and group 3 (steroid+seawater) at week 2 (p< 0.001 in both groups) and week 6 (p< 0.0001 in both groups) compared to group 1 (steroid), along with a significant decrease of intranasal corticosteroids (p < 0.0001). Patient health status improved in group 2 and group 3 at week 2 (p= 0.1040 and p< 0.001 respectively) compa­red to control (steroid), and this improvement was significantly greater in both groups at week 6 compared to steroid group (p< 0.0001). Conclusion: Hypertonic nasal irrigation is an effective treatment for CRS in adults. It significantly improved nasal symptoms and allowed a signi­fi­cant decrease of intranasal corticosteroids use while improving patient health status. Nasal irrigation with 2.2% hypertonic seawater could therefore be considered as first-line treatment for CRS, either as monotherapy or in combination with lower dosage of intranasal corticosteroids.